[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6303 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 6303
To improve Federal efforts with respect to the prevention of maternal
mortality, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
November 25, 2025
Ms. Kelly of Illinois introduced the following bill; which was referred
to the Committee on Energy and Commerce, and in addition to the
Committees on Education and Workforce, and Ways and Means, for a period
to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To improve Federal efforts with respect to the prevention of maternal
mortality, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Community Access, Resources, and
Empowerment for Moms Act'' or the ``CARE for Moms Act''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Every year, across the United States, nearly 4,000,000
women give birth, more than 1,000 women suffer fatal
complications during pregnancy, while giving birth or during
the postpartum period, and about 70,000 women suffer near-
fatal, partum-related complications.
(2) The maternal mortality rate is often used as a proxy to
measure the overall health of a population. While the infant
mortality rate in the United States has reached its lowest
point, the risk of death for women in the United States during
pregnancy, childbirth, or the postpartum period is higher than
such risk in many other high-income countries. The estimated
maternal mortality rate (deaths per 100,000 live births) for
the 48 contiguous States and Washington, DC, increased from
14.5 percent in 2000 to 32.0 in 2021. The United States is the
only industrialized nation with a rising maternal mortality
rate.
(3) The National Vital Statistics System of the Centers for
Disease Control and Prevention has found that in 2021, there
were 32.9 maternal deaths for every 100,000 live births in the
United States. That ratio continues to exceed the rate in other
high-income countries.
(4) It is estimated that more than 80 percent of maternal
deaths in the United States are preventable.
(5) According to the Centers for Disease Control and
Prevention, the maternal mortality rate varies drastically for
women by race and ethnicity. There are about 26.6 deaths per
100,000 live births for White women, 69.9 deaths per 100,000
live births for non-Hispanic Black women, and 32.0 deaths per
100,000 live births for American Indian/Alaska Native women.
While maternal mortality disparately impacts Black women, this
urgent public health crisis traverses race, ethnicity,
socioeconomic status, educational background, and geography.
(6) In the United States, non-Hispanic Black women are
about 3 times more likely to die from causes related to
pregnancy and childbirth compared to non-Hispanic White women,
which is one of the most disconcerting racial disparities in
public health. This disparity widens in certain cities and
States across the country.
(7) According to the National Center for Health Statistics
of the Centers for Disease Control and Prevention, the maternal
mortality rate heightens with age, as women 40 and older die at
a rate of 138.5 per 100,000 births compared to 20.4 per 100,000
for women under 25. This translates to women over 40 being 6.8
times more likely to die compared to their counterparts under
25 years of age.
(8) The COVID-19 pandemic has exacerbated the maternal
health crisis. A study of the Centers for Disease Control and
Prevention suggested that pregnant women are at a significantly
higher risk for severe outcomes, including death, from COVID-19
as compared to non-pregnant women. The COVID-19 pandemic also
decreased access to prenatal and postpartum care. A study by
the Government Accountability Office found that COVID-19
contributed to 25 percent of maternal deaths in 2020 and 2021.
(9) The findings described in paragraphs (1) through (8)
are of major concern to researchers, academics, members of the
business community, and providers across the obstetric
continuum represented by organizations such as--
(A) the American College of Nurse-Midwives;
(B) the American College of Obstetricians and
Gynecologists;
(C) the American Medical Association;
(D) the Association of Women's Health, Obstetric
and Neonatal Nurses;
(E) the Black Mamas Matter Alliance;
(F) the Black Women's Health Imperative;
(G) the California Maternal Quality Care
Collaborative;
(H) EverThrive Illinois;
(I) the Illinois Perinatal Quality Collaborative;
(J) the March of Dimes;
(K) the National Association of Certified
Professional Midwives;
(L) RH Impact: The Collaborative for Equity and
Justice;
(M) the National Partnership for Women & Families;
(N) the National Polycystic Ovary Syndrome
Association;
(O) the Preeclampsia Foundation;
(P) the Society for Maternal-Fetal Medicine;
(Q) the What To Expect Project;
(R) Tufts University School of Medicine Center for
Black Maternal Health and Reproductive Justice;
(S) the Shades of Blue Project;
(T) the Maternal Mental Health Leadership Alliance;
(U) the Tulane University Mary Amelia Center for
Women's Health Equity Research;
(V) In Our Own Voice: National Black Women's
Reproductive Justice Agenda; and
(W) Physicians for Reproductive Health.
(10) Hemorrhage, cardiovascular and coronary conditions,
cardiomyopathy, infection or sepsis, embolism, mental health
conditions (including substance use disorder), hypertensive
disorders, stroke and cerebrovascular accidents, and anesthesia
complications are the predominant medical causes of maternal-
related deaths and complications. Most of these conditions are
largely preventable or manageable. Even when these conditions
are not preventable, mortality and morbidity may be prevented
when conditions are diagnosed and treated in a timely manner.
(11) According to a study published by the Journal of
Perinatal Education, doula-assisted mothers are 4 times less
likely to have a low-birthweight baby, 2 times less likely to
experience a birth complication involving themselves or their
baby, and significantly more likely to initiate breastfeeding
and human lactation. Doula care has also been shown to produce
cost savings resulting in part from reduced rates of cesarean
and pre-term births.
(12) Intimate partner violence is one of the leading causes
of maternal death, and women are more likely to experience
intimate partner violence during pregnancy than at any other
time in their lives. It is also more dangerous than pregnancy.
Intimate partner violence during pregnancy and postpartum
crosses every demographic and has been exacerbated by the
COVID-19 pandemic.
(13) Oral health is an important part of perinatal health.
Reducing bacteria in a woman's mouth during pregnancy can
significantly reduce her risk of developing oral diseases and
spreading decay-causing bacteria to her baby. Moreover, some
evidence suggests that women with periodontal disease during
pregnancy could be at greater risk for poor birth outcomes,
such as preeclampsia, pre-term birth, and low-birth weight.
Furthermore, a woman's oral health during pregnancy is a good
predictor of her newborn's oral health, and since mothers can
unintentionally spread oral bacteria to their babies, putting
their children at higher risk for tooth decay, prevention
efforts should happen even before children are born, as a
matter of pre-pregnancy health and prenatal care during
pregnancy.
(14) In the United States, death reporting and analysis is
a State function rather than a Federal process. States report
all deaths--including maternal deaths--on a semi-voluntary
basis, without standardization across States. While the Centers
for Disease Control and Prevention has the capacity and system
for collecting death-related data based on death certificates,
these data are not sufficiently reported by States in an
organized and standard format across States such that the
Centers for Disease Control and Prevention is able to identify
causes of maternal death and best practices for the prevention
of such death.
(15) Vital statistics systems often underestimate maternal
mortality and are insufficient data sources from which to
derive a full scope of medical and social determinant factors
contributing to maternal deaths, such as intimate partner
violence. While the addition of pregnancy checkboxes on death
certificates since 2003 have likely improved States' abilities
to identify pregnancy-related deaths, they are not generally
completed by obstetric providers or persons trained to
recognize pregnancy-related mortality. Thus, these vital forms
may be missing information or may capture inconsistent data.
Due to varying maternal mortality-related analyses, lack of
reliability, and granularity in data, current maternal
mortality informatics do not fully encapsulate the myriad
medical and socially determinant factors that contribute to
such high maternal mortality rates within the United States
compared to other developed nations. Lack of standardization of
data and data sharing across States and between Federal
entities, health networks, and research institutions keep the
Nation in the dark about ways to prevent maternal deaths.
(16) Having reliable and valid State data aggregated at the
Federal level are critical to the Nation's ability to quell
surges in maternal death and imperative for researchers to
identify long-lasting interventions.
(17) Leaders in maternal wellness highly recommend that
maternal deaths and cases of maternal morbidity, including
complications that result in chronic illness and future
increased risk of death, be investigated at the State level
first, and that standardized, streamlined, de-identified data
regarding maternal deaths be sent annually to the Centers for
Disease Control and Prevention. Such data standardization and
collection would be similar in operation and effect to the
National Program of Cancer Registries of the Centers for
Disease Control and Prevention and akin to the Confidential
Enquiry in Maternal Deaths Programme in the United Kingdom.
Such a maternal mortalities and morbidities registry and
surveillance system would help providers, academicians,
lawmakers, and the public to address questions concerning the
types of, causes of, and best practices to thwart, maternal
mortality and morbidity.
(18) The United Nations' Millennium Development Goal 5a
aimed to reduce by 75 percent, between 1990 and 2015, the
maternal mortality rate, yet this metric has not been achieved.
In fact, the maternal mortality rate in the United States has
been estimated to have more than doubled between 2000 and 2014.
(19) The United States has no comparable, coordinated
Federal process by which to review cases of maternal mortality,
systems failures, or best practices. The majority of States
have active Maternal Mortality Review Committees (referred to
in this section as ``MMRC''), which help leverage work to
impact maternal wellness. For example, the State of California
has worked extensively with their State health departments,
health and hospital systems, and research collaborative
organizations, including the California Maternal Quality Care
Collaborative and the Alliance for Innovation on Maternal
Health, to establish MMRCs, wherein such State has determined
the most prevalent causes of maternal mortality and recorded
and shared data with providers and researchers, who have
developed and implemented safety bundles and care protocols
related to preeclampsia, maternal hemorrhage, peripartum
cardiomyopathy, and the like. In this way, the State of
California has been able to leverage its maternal mortality
review board system, generate data, and apply those data to
effect changes in maternal care-related protocol.
(20) Hospitals and health systems across the United States
lack standardization of emergency obstetric protocols before,
during, and after delivery. Consequently, many providers are
delayed in recognizing critical signs indicating maternal
distress that quickly escalate into fatal or near-fatal
incidences. Moreover, any attempt to address an obstetric
emergency that does not consider both clinical and public
health approaches falls woefully under the mark of excellent
care delivery. State-based perinatal quality collaboratives, or
entities participating in the Alliance for Innovation on
Maternal Health (AIM), have formed obstetric protocols, tool
kits, and other resources to improve system care and response
as they relate to maternal complications and warning signs for
such conditions as maternal hemorrhage, hypertension, and
preeclampsia. These perinatal quality collaboratives serve an
important role in providing infrastructure that supports
quality improvement efforts addressing obstetric care and
outcomes. State-based perinatal quality collaboratives partner
with hospitals, physicians, nurses, midwives, patients, public
health, and other stakeholders to provide opportunities for
collaborative learning, rapid response data, and quality
improvement science support to achieve systems-level change.
(21) The Centers for Disease Control and Prevention reports
that 22 percent of deaths occurred during pregnancy, 25 percent
occurred on the day of delivery or within 7 days after the day
of delivery, and 53 percent occurred between 7 days and 1 year
after the day of delivery. Yet, for women eligible for the
Medicaid program on the basis of pregnancy in States without
Medicaid postpartum extension, such Medicaid coverage lapses at
the end of the month on which the 60th postpartum day lands.
(22) The experience of serious traumatic events, such as
being exposed to domestic violence, substance use disorder, or
pervasive and systematic racism, can over-activate the body's
stress-response system. Known as toxic stress, the repetition
of high-doses of cortisol to the brain, can harm healthy
neurological development and other body systems, which can have
cascading physical and mental health consequences, as
documented in the Adverse Childhood Experiences study of the
Centers for Disease Control and Prevention.
(23) A growing body of evidence-based research has shown
the correlation between the stress associated with systematic
racism and one's birthing outcomes. The undue stress of sex and
race discrimination paired with institutional racism has been
demonstrated to contribute to a higher risk of maternal
mortality, irrespective of one's gestational age, maternal age,
socioeconomic status, educational level, geographic region, or
individual-level health risk factors, including poverty,
limited access to prenatal care, and poor physical and mental
health (although these are not nominal factors). Black women
remain the most at risk for pregnancy-associated or pregnancy-
related causes of death. When it comes to preeclampsia, for
example, for which obesity is a risk factor, Black women of
normal weight remain at a higher at risk of dying during the
perinatal period compared to non-Black obese women.
(24) The rising maternal mortality rate in the United
States is driven predominantly by the disproportionately high
rates of Black maternal mortality.
(25) Compared to women from other racial and ethnic
demographics, Black women across the socioeconomic spectrum
experience prolonged, unrelenting stress related to systematic
racial and gender discrimination, contributing to higher rates
of maternal mortality, giving birth to low-weight babies, and
experiencing pre-term birth. Racism is a risk-factor for these
aforementioned experiences. This cumulative stress, called
weathering, often extends across the life course and is
situated in everyday spaces where Black women establish
livelihood. Systematic racism, structural barriers, lack of
access to quality maternal health care, lack of access to
nutritious food, and social determinants of health exacerbate
Black women's likelihood to experience poor or fatal birthing
outcomes, but do not fully account for the great disparity.
(26) Black women are twice as likely to experience
postpartum depression, and disproportionately higher rates of
preeclampsia compared to White women.
(27) Racism is deeply ingrained in United States systems,
including in health care delivery systems between patients and
providers, often resulting in disparate treatment for pain,
irreverence for cultural norms with respect to health, and
dismissiveness. However, the provider pool is not primed with
many people o